Deferoxamine

Deferoxamine, also known as desferrioxamine, is an iron chelating agent used to treat acute iron poisoning and chronic iron overload from repeated blood transfusions. It is a hexadentate ligand that binds ferric iron (Fe3+) with high affinity to form ferrioxamine complexes, which are primarily excreted in the urine, thereby reducing the body's iron burden. While it can bind other trivalent metals in vitro, its clinical use is mainly for iron chelation; it has historical use in aluminum toxicity as well.

Because deferoxamine has poor oral bioavailability, it is administered parenterally, typically by intravenous infusion, intramuscular injection, or subcutaneous infusion. For acute iron poisoning, dosing is weight-based and given under close clinical and laboratory monitoring; regimens aim to rapidly chelate circulating iron and are adjusted according to clinical response and iron indices. For transfusional iron overload, long-term therapy uses lower daily doses delivered by subcutaneous infusion via a portable pump, often in the range of 20–40 mg/kg per day, with adjustments based on ferritin levels and liver iron concentration.

Adverse effects include infusion-related reactions such as hypersensitivity and flushing, hypotension, fever, and local injection-site reactions. Less common but serious risks include anaphylaxis, nephrotoxicity, and, with prolonged use, ocular or auditory disturbances. Renal function should be monitored, and therapy may be modified in patients with renal impairment. Deferoxamine is typically administered under medical supervision, with ongoing assessment of iron status through ferritin, transferrin saturation, and, when available, liver iron concentration.